This application is for a national prospective 3 year descriptive study of restructuring's impact on outcomes in 30 university teaching hospitals (UTHs). The participating hospitals are members of the University HealthSystem Consortium, operate 300 or more acute beds and participate in the MECON labor benchmarking program. The aims are to: l) describe the restructuring and reengineering activities occurring in the organization and delivery of patient care, and in particular nursing care in the UTHs; 2) determine the inter-relationships of selected structural variables,e.g., restructuring and reengineering activities, staff mix, worked nursing hours per patient day, total nursing expenses per day/per discharge, with selected process variables, e.g., culture, leadership, collaboration, staff satisfaction to patient outcomes, e.g., nosocomial pressure ulcers, falls and injury rate from falls, nosocomial urinary track infection rates, pain management and patient satisfaction; and 3) evaluate relationships of skill mix and worked nursing hours per patient day to patient outcomes and determine ff data suggest standards supportive of quality patient care outcomes. This study will contribute much needed information on the restructuring and reengineering activities that are taking place and data to answer the questions: Are they producing desired results? Are midcourse corrections advisable? Equally important is the demonstration that data on nurse sensitive outcomes indicative of quality care can be collected in a uniform manner, facilitating interinstitutional comparisons and benchmarking studies integral to continuing quality improvement and cost effectiveness.